In recent decades, the aim of finding new agents for the treatment of autistic spectrum disorders accompanied by severe cognitive impairments becomes more medically and socially important in view of the duration of treatment, severe disability and maladjustment of patients with autistic spectrum disorders (V. M. Bashina, Childhood Autism, Moscow, “Meditsina”, 1999).
Childhood autism is characterized by disorders of psychological development, autistic form of contact with others, disorders of speech and motor skills, activities and stereotyped behavior that lead to social maladjustment. A generally accepted concept of the etiology of autistic disorders does not currently exist. The reasons are different—from endogenous genetic to exogenous organic and psychogenic. Childhood autism is considered to have a neurobiological basis and to be a result of general brain disorders.
There are known medicaments for the treatment of autistic spectrum disorders accompanied by severe cognitive impairments, which include, first of all, neuroleptics. Among neuroleptics for the treatment of autistic disorders with severe cognitive impairments there are useful aminazine, neuleptil, haloperidol, teraligen, triphtazine, eglonil, azaleptin, chlorprothixene. In addition, such conditions are treated with antidepressants (anafranil, azaphene, pirazidole, amitriptyline, etc.), anticonvulsants (finlepsin, trileptal, topamax). (V. V. Kovalev, Psychiatry of childhood, Moscow, “Meditsin”, 1979; V. M. Bashina, Childhood autism, Moscow, “Medicine”, 1999).
It should be noted that the use of neuroleptics is accompanied by a high risk of undesirable side effects including extrapyramidal disorders, neuroleptic malignant syndrome, etc. A long-term treatment with such neuroleptics and other psychotropic agents results in evident side effects; they can cause psychological, neurological, and somato-vegetative disorders, which certainly limits the duration required for the neuroleptic therapy to be effective.
Sometimes, nootropics are used for the treatment of autistic disorders with severe cognitive impairments, as additional medicaments. Nootropics are considered to have a direct activating effect on learning, improving memory and mental activity, i.e. cognitive function. The most commonly used nootropics in the treatment of autistic disorders with severe cognitive impairments are glycine, nootropil (Pyracetam), encephabol (Pyriditol), aminalone (Gammalon), tanakan (L. M. Kuzenkova, O. I. Maslova, L. S. Namazova, etc., Nootropics in cognitive neuroscience in childhood//Manual for physicians, M., 2008, p. 54). Dose regimen of nootropics is adjusted individually. Although nootropics are basically characterized by good tolerability in children with severe intellectual maldevelopment, their administration can lead to increased motor disinhibition, irritability, hyperthymia, and sleep impairment. Nootropics are described to have other side effects: Piracetam can cause dyspeptic disorders and increased coronary insufficiency; aminalone can cause dyspeptic disorders, fever-sensation and changes in blood pressure; Pyriditol can cause nausea and headache, and in children—psychomotor agitation. With that, Pyracetam is contraindicated in renal failure; Pyriditol is contraindicated in high convulsion-readiness (L. M. Kuzenkova, O. I. Maslova, L. S. Namazova et al., Nootropics in cognitive neuroscience in childhood//Manual for physicians, M., 2008, p. 54; S. Yu. Shtrygol, T. V. Kortunova, D. V. Shtrygol, Side Effects of Nootropics, Provisor, 2003, Issue 11).
In addition, in recent years a complex therapy with the above indicated drugs is most effective for the treatment of autistic disorders with severe cognitive impairments. However, in this case, patients with very severe forms of autism often demonstrate resistance to neuroleptics, which requires increasing the average daily doses of medicaments. In this case, a desired effect is not always observed, and side effects are often increased.
In this context, the search for new additional agents for pathogenic therapy allowing for enhanced safety and efficacy of the treatment of mental illness is an important clinical and social challenge.